The ethical problems with informed consent: How inconsistencies undermine patient autonomy

To identify inconsistencies in informed consent (IC) and evaluate how these variations impact patient autonomy.

A review of IC policies at different institutions and literature was conducted, analyzing variations in consent practices.

Significant variability exists in IC implementation. Thresholds for consent often seem arbitrary, with comparable-risk procedures requiring different approaches (e.g., arterial lines needing written consent while peripheral IVs do not). Context also drives disclosure; the risk of nerve injury may be emphasized before a mastectomy but not a cardiac procedure. Bundled consents, such as ICU admission forms covering multiple interventions, can obscure individual risks. Efficiency pressures can dictate who obtains consent, leading less experienced providers to perform it. Witness requirements are inconsistent, varying between phone and in-person discussions.

Current IC practices are fragmented, influenced by factors beyond patient-centered care. These inconsistencies result in gaps in the support of patient decision-making. Standardized, patient-centered policies are needed to protect patient autonomy.